Intensive care after digestive surgery: the outcome in elderly patients.

Study aim: In surgical intensive care, the results must be analyzed both in terms of mortality and quality of life; this is particularly important in elderly patients for whom recovery remains uncertain. The aim of this prosp ective study was to assess the early and late prognosis in elderly patients (aged over 75 years) admitted to a digestive surgical intensive care unit (DSICU) for mortality, quality of life, patient autonomy, and also the pred ictive factors involved. Patients and methods: Over a one-year period, 182 patients were admitted to a tertiary referral DSICU; 30 of these subjects were over 75 years old, an d formed the basis of this study. The following data were analyzed: hospita l mortality rate; mortality rate at six months, and quality of life at six months (Karnofsky scale). These factors were correlated with the severity o f the patient's state at admission and also with the causal disease, circum stances connected with admission, and duration of stay in the DSICU. Results: The hospital mortality rate of patients was 23% (7/30 patients), a nd the overall mortality rate at six months was 40% (12/30 patients). Of th e 12 patients who stayed in the DSICU for more than ten days with a simplif ied acute physiology score (APS) = 10, not one was alive at six months post -DSICU admission. The 18 remaining patients were still alive at six months, and 72% of them (13/18 patients) had regained their previous post-operativ e autonomy. Conclusion: These results provide reference data for this patient category. The results concerning long-term survival and the good functional outcome are encouraging. If the prognostic criteria defined in this investigation a re confirmed by further studies, they may help in making the sometimes diff icult decisions regarding elderly patients hospitalized in a DSICU. (C) 200 0 Editions scientifiques et medicales Elsevier SAS.